Wide local excision for Merkel cell carcinoma of the lower extremity: A case report

Zhang,Yong; Sun,Yan; Mo,Juefei

doi:10.3892/etm.2022.11636

Wide local excision for Merkel cell carcinoma of the lower extremity: A case report

Authors:
- Yong Zhang
- Yan Sun
- Juefei Mo
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Affiliations: Department of General Surgery, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P.R. China
Published online on: September 29, 2022 https://doi.org/10.3892/etm.2022.11636
Article Number: 700
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Primary Merkel cell carcinoma (MCC) is rare and wide local excision is the primary method of treatment. However, no consensus has been reached on the best surgical approach and research is currently limited. The choice of surgical method depends on the experience of the surgeon and the situation of the patient. In the present study, the clinical data of a single case of primary MCC that was treated with wide local excision in June 2019 were retrospectively analyzed and the associated literature was reviewed. The patient underwent complete resection of the tumor, which extended 2 cm from the outer edge of the nodule and reached the subcutaneous fat layer. The wound was closed with a tension‑relieving suture. The stitches were removed 15 days following surgery and the wound had healed adequately. No recurrence occurred during 30 months of follow‑up. However, further multi‑center prospective randomized clinical trials are required for further investigation.

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1	Harvey JA, Mirza SA, Erwin PJ, Chan AW, Murad MH and Brewer JD: Recurrence and mortality rates with different treatment approaches of Merkel cell carcinoma: A systematic review and meta-analysis. Int J Dermatol. 61:687–697. 2022.PubMed/NCBI View Article : Google Scholar
2	Perez MC and Zager JS: Aso author reflections: Resection margins in merkel cell carcinoma: Is a 1 cm margin wide enough? Ann Surg Oncol. 25 (Suppl 3)(S901)2018.PubMed/NCBI View Article : Google Scholar
3	Toker C: Trabecular carcinoma of the skin. Arch Dermatol. 105:107–110. 1972.PubMed/NCBI
4	Paulson KG, Park SY, Vandeven NA, Lachance K, Thomas H, Chapuis AG, Harms KL, Thompson JA, Bhatia S, Stang A and Nghiem P: Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol. 78:457–463.e2. 2018.PubMed/NCBI View Article : Google Scholar
5	Schadendorf D, Lebbe C, Zur Hausen A, Avril MF, Hariharan S, Bharmal M and Becker JC: Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs. Eur J Cancer. 71:53–69. 2017.PubMed/NCBI View Article : Google Scholar
6	Rollison DE, Giuliano AR and Becker JC: New virus associated with merkel cell carcinoma development. J Natl Compr Canc Netw. 8:874–880. 2010.PubMed/NCBI View Article : Google Scholar
7	Bichakjian CK, Olencki T, Alam M, Andersen JS, Berg D, Bowen GM, Cheney RT, Daniels GA, Glass LF, Grekin RC, et al: Merkel cell carcinoma, version 1.2014. J Natl Compr Canc Netw. 12:410–424. 2014.PubMed/NCBI View Article : Google Scholar
8	Becker J, Mauch C, Kortmann RD, Keilholz U, Bootz F, Garbe C, Hauschild A and Moll I: Short german guidelines: Merkel cell carcinoma. J Dtsch Dermatol Ges. 6 (Suppl 1):S15–S16. 2008.PubMed/NCBI View Article : Google Scholar : (In English, German).
9	Doepker MP, Thompson ZJ, Fisher KJ, Yamamoto M, Nethers KW, Harb JN, Applebaum MA, Gonzalez RJ, Sarnaik AA, Messina JL, et al: Is a wider margin (2 cm vs. 1 cm) for a 1.01-2.0 mm melanoma necessary? Ann Surg Oncol. 23:2336–2342. 2016.PubMed/NCBI View Article : Google Scholar
10	Strom T, Carr M, Zager JS, Naghavi A, Smith FO, Cruse CW, Messina JL, Russell J, Rao NG, Fulp W, et al: Radiation therapy is associated with improved outcomes in merkel cell carcinoma. Ann Surg Oncol. 23:3572–3578. 2016.PubMed/NCBI View Article : Google Scholar
11	Bichakjian CK, Olencki T, Aasi SZ, Alam M, Andersen JS, Blitzblau R, Bowen GM, Contreras CM, Daniels GA, Decker R, et al: Merkel cell carcinoma, version 1.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 16:742–774. 2018.PubMed/NCBI View Article : Google Scholar
12	Shaikh WR, Sobanko JF, Etzkorn JR, Shin TM and Miller CJ: Utilization patterns and survival outcomes after wide local excision or mohs micrographic surgery for merkel cell carcinoma in the United States, 2004-2009. J Am Acad Dermatol. 78:175–177.e3. 2018.PubMed/NCBI View Article : Google Scholar
13	Terushkin V, Brodland DG, Sharon DJ and Zitelli JA: Mohs surgery for early-stage Merkel cell carcinoma (MCC) achieves local control better than wide local excision +/- radiation therapy with no increase in MCC-specific death. Int J Dermatol. 60:1010–1012. 2021.PubMed/NCBI View Article : Google Scholar
14	Yan L, Sun L, Guan Z, Wei S, Wang Y and Li P: Analysis of cutaneous merkel cell carcinoma outcomes after different surgical interventions. J Am Acad Dermatol. 82:1422–1434. 2020.PubMed/NCBI View Article : Google Scholar
15	Schwartz JL, Wong SL, Mclean SA, Hayman JA, Lao CD, Kozlow JH, Malloy KM, Bradford CR, Frohm ML, Fullen DR, et al: NCCN guidelines implementation in the multidisciplinary Merkel cell carcinoma program at the university of Michigan. J Natl Compr Canc Netw. 12:434–441. 2014.PubMed/NCBI View Article : Google Scholar
16	Tai P: A practical update of surgical management of merkel cell carcinoma of the skin. ISRN Surg. 2013(850797)2013.PubMed/NCBI View Article : Google Scholar
17	Dellambra E, Carbone ML, Ricci F, Ricci F, Di Pietro FR, Moretta G, Verkoskaia S, Feudi E, Failla CM, Abeni D and Fania L: Merkel cell carcinoma. Biomedicines. 9(718)2021.PubMed/NCBI View Article : Google Scholar
18	Singh B, Qureshi MM, Minh TT and Sahni D: Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the National cancer database. J Am Acad Dermatol. 79:126–134.e3. 2018.PubMed/NCBI View Article : Google Scholar
19	Lebbe C, Becker JC, Grob JJ, Malvehy J, Del Marmol V, Pehamberger H, Peris K, Saiag P, Middleton MR, Bastholt L, et al: Diagnosis and treatment of Merkel cell carcinoma. European consensus-based interdisciplinary guideline. Eur J Cancer. 51:2396–2403. 2015.PubMed/NCBI View Article : Google Scholar
20	Kinas CG and Carroll BT: General guidelines for quality assurance of immunohistochemistry in a Mohs lab. Dermatol Surg. 43:507–511. 2017.PubMed/NCBI View Article : Google Scholar
21	Hughes MP, Hardee ME, Cornelius LA, Hutchins LF, Becker JC and Gao L: Merkel cell carcinoma: Epidemiology, target, and therapy. Curr Dermatol Rep. 3:46–53. 2014.PubMed/NCBI View Article : Google Scholar
22	Garza-Davila VF, Valdespino-Valdes J, Barrera FJ, Ocampo-Candiani J and Garza-Rodríguez V: Clinical impact of immunotherapy in Merkel cell carcinoma patients: A systematic review and meta-analysis. J Am Acad Dermatol. 87:121–130. 2022.PubMed/NCBI View Article : Google Scholar
23	Lee AY and Berman RS: The landmark series: Non-melanoma skin cancers. Ann Surg Oncol. 27:22–27. 2020.PubMed/NCBI View Article : Google Scholar
24	Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, et al: Durable tumor regression and overall survival in patients with advanced Merkel cell carcinoma receiving pembrolizumab as first-line therapy. J Clin Oncol. 37:693–702. 2019.PubMed/NCBI View Article : Google Scholar
25	D'Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, et al: Avelumab in patients with previously treated metastatic Merkel cell carcinoma: Long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial. J Immunother Cancer. 8(e000674)2020.PubMed/NCBI View Article : Google Scholar
26	Topalian SL, Bhatia S, Amin A, Kudchadkar RR, Sharfman WH, Lebbé C, Delord JP, Dunn LA, Shinohara MM, Kulikauskas R, et al: Neoadjuvant nivolumab for patients with resectable merkel cell carcinoma in the checkmate 358 trial. J Clin Oncol. 38:2476–2487. 2020.PubMed/NCBI View Article : Google Scholar